Ennoble Hc Nj III PC
NPI 1043192099ActiveOrganization· Family Medicine, Geriatric Medicine· Hackensack, NJ
Family Medicine, Geriatric Medicine in Hackensack, New Jersey, registered in NPPES in July 2025. The authorized official on file is Mark Bradshaw, MD, Owner. Enrolled in Medicare as part b supplier - clinic/group practice and part b supplier - clinic/group practice.
Overview
| NPI | 1043192099 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 22, 2025 |
| Last updated in NPPES | Aug 29, 2025 |
| Certified by provider | Aug 29, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine, Geriatric Medicine Primary | 207QG0300X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (DE); Part B Supplier - Clinic/Group Practice (MA); Part B Supplier - Clinic/Group Practice (NJ); Part B Supplier - Clinic/Group Practice (OK); Part B Supplier - Clinic/Group Practice (PA) |
|---|
Other Family Medicine, Geriatric Medicine providers in Hackensack
- 1568380897
- 1629996954
- 1285560490
- 1639005853
- 1275469488
- 1174445712
- 1871475806
- 1306500764
- 1265352009
- 1639097702
- 1306121504
- 1780039404
All Family Medicine, Geriatric Medicine providers in New Jersey →